LTC Bullet: Why Keep Fighting … and How

Thursday, September 6, 2018


LTC Comment: Responsible long-term care planning is on the ropes. Government dependency prevails. Worse, we’ll get more of the latter and less of the former in the short run. Give up or fight on, after the ***news.***

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LTC Comment: Here’s the problem:

  • Most of the public is finally aware of long-term care risk and cost, but the vast majority still fail to plan, save, invest or insure privately.

  • LTC insurance is out of favor and many carriers, distributors and producers have migrated partially or wholly to other products.

  • Medicaid continues to fund most high-cost LTC, while paying providers less than cost, exacerbating quality problems.

  • Plans to expand public LTC financing abound without serious strategies to pay for them.

  • Media coverage is frequently inaccurate and biased, but mostly uncontested.

  • Asset bubbles and deep debt due to irresponsible government monetary and fiscal policies threaten the economy.

  • We’re little more than a decade away from the 2030s when boomers start turning 85, their medical and LTC expenses explode, and their entitlement safety nets (Social Security, Medicare and Medicaid) implode.

  • Time is running out.

What a mess! What’s the use? Why not give up and move on?

Well, read through that litany of travails again and ask yourself what’s different? Most of it reflects errors of public policy that have prevailed for decades, but remain untenable indefinitely. The late economist Herb Stein said "If something cannot go on forever, it will stop," often paraphrased “Trends that can’t continue, won’t.” The LTC financing status quo cannot go on forever. Therefore, it will end. So the right question is not what’s the use? But rather, how can we make the most of this stupendous opportunity to understand, anticipate and get in front of a major, forthcoming social and economic sea change? Disrupt or be disrupted!

Comparable Considerations

Consider this analogy. Stocks just achieved the longest bull market in history. Do you sell out entirely now? If you’d done that when this bull run was the second or third longest in history, you’d have missed, as many did, a big portion of the profits from holding on. If the bull market finally ends and stocks plummet, will you sell then and risk getting out at the bottom, the opposite of good “buy low, sell high” advice, or will you buy more trying to “catch a falling knife” against most professional investment counsel? No, wise investors dollar-cost average into the market, diversify domestically and internationally, take profits occasionally, look for unique opportunities, remain ever vigilant to changes in the economy, and purchase insurance against financial cataclysms by holding some hard assets such as gold that are resistant to recessions and fiat currency risk. Awareness, analysis, research, persistence and insurance are the watchwords for successful investing.

Same Principles Applied to Long-Term Care Policy Reform

Likewise, what would be comparable principles and responses to address the current bear market in long-term care financing policy?

Awareness: Understand the problem; know what we’re facing; stay abreast of the latest news, studies, journal articles, legislation and public policy affecting long-term care services and financing. Here’s how the Center for Long-Term Care Reform helps:

  • Our daily LTC Clippings briefly highlight critical new information and developments

  • Our LTC E-Alerts summarize the previous week’s LTC Clippings in one quick read

  • Our LTC Bullets analyze larger policy trends, major reports, and academic articles. Search the Bullets here and you’ll find 1,235 of them archived both chronologically and by topic. To wit:

  • The LTC Problem and Solutions: 293

  • Reality Check: The Facts on LTCI: 130

  • Medicaid Planning: 151

  • LTC Services: 184

  • Politics and Legislation: 174

  • Demographics and Other Data: 119

  • CLTCR News: 215
    Total: 1266 (A few Bullets straddle topics and therefore are listed under more than one heading.)

  • Our members-only website provides many more features to facilitate professional expertise and excellence. Non-members may access these free for one week at user name: IntrotoZone and password: FreeTrial (case sensitive)

Analysis: Having provided all the tools necessary to keep you abreast of everything going on in the long-term care financing field, we focus frequently on broader analysis, making sense of new developments, praising if they’re positive, and criticizing otherwise. Browse these for example:

  • The Still Broken Rhythm of Long-Term Care Reform, July 20, 2018: Why did Medicaid long-term care eligibility reforms quickly follow economic recessions until the year 2000, but no longer?

  • The New Fallacy of Impoverishment, June 29, 2018: Government should declare success in the War on Poverty and eliminate policies that discourage personal responsibility and work.

  • Feder Fantasy Fatally Flawed, May 4, 2018: A new Feder/Cohen proposal would take long-term care out of the frying pan into the fire.

  • The End of Alzheimer’s, April 20, 2018: Is there hope for delaying, mitigating, even ending Alzheimer’s? We report, you decide.

  • Have Your Cake Until It Eats You, March 23, 2018: Americans want to have their cake (entitlements) and eat it too, but scary evidence and trends show this cake will eat our economy first.

  • LTC Calculation, February 16, 2018: We explore why socialism always fails, especially when applied to long-term care.

  • LTC Cause and Effect, February 9, 2018: New Bipartisan Policy Center LTC report puts the services cart before the financing horse as usual.

  • Don’t Buy LTCI?!, January 12, 2018: Bad advice by the unknowing spread by the unwitting refuted by understanding.

  • The Morality of Hazards, November 10, 2017: If conventional morality is a trap, what would work better?

  • The Hazards of Morality, November 3, 2017: Is conventional morality a trap? Could we have it all backwards?

  • Is it Spend Down or Medicaid Planning?, July 14, 2017: A lot of what passes for Medicaid “spend down” in the scholarly literature is really Medicaid planning. We explain and give examples.

  • Home Equity and LTCI Demand, June 30, 2017: We affirm and confirm Professor Thomas Davidoff’s observations on the connection between home equity and LTC insurance demand.

Keep browsing 20 years of LTC Bullets archives and you will find our trenchant analysis of every major LTC financing development and proposal during that period.

Research: It’s not enough to stay current with the LTC literature and to analyze developments carefully. We must push the boundaries of knowledge especially in areas, such as the benefits of freer markets and the downsides of over-reliance on government, where many conventional scholars refuse to go. Steve Moses and the Center for Long-Term Care Reform have conducted and published such original research on long-term care financing for over 30 years. Examples include:

Persistence: Your Center for Long-Term Care Reform has pursued these principles in these ways for over 20 years, since April 1, 1998. We’ve faced the same challenges so many of you struggle to overcome. But like thoughtful investors, we don’t panic and sell. We carefully evaluate the challenge, adjust to meet it in evermore creative ways, keep our powder dry, and await the next big opportunity to effectuate change for the better. We remain proactive, supporting good ideas, opposing bad ideas, and proposing new approaches.

We remember and are buoyed by our major successes changing long-term care financing law and regulations for the better, including

(1) forging the framework for the Omnibus Budget Reconciliation Act of 1993, which closed many Medicaid eligibility loopholes, made estate recoveries mandatory, and implemented most of the recommendation from the 1988 "Medicaid Estate Recovery" report Steve Moses wrote for the Office of Inspector General [] and

(2) influencing (with co-founder, attorney David Rosenfeld) the content and passage of the Deficit Reduction Act of 2005, which capped Medicaid’s home equity exemption for the first time, extended the asset transfer look back period to a full five years, and unleashed the long-hamstrung LTC Partnership program from debilitating statutory restraints.

We did it before. We can do it again.

Insurance: Like buying gold to insure an investment portfolio against inflation, recession, and stagflation, supporting your Center for Long-Term Care Reform ensures that we’ll be there fighting for sound long-term care financing policy, keeping you apprised of all you need to know, taking every opportunity to correct errors by ideologically biased analysts or media, and seeking every opening to effectuate changes that benefit private LTC financing products and producers.

LTC Comment: I started to title today’s LTC Bullet “Why You Need the Center for Long-Term Care Reform.” But then I figured you might not read what I had to say. So I took the tack of assessing the problems we face and pointing out how the Center for Long-Term Care Reform addresses them with careful analysis, realistic recommendations, and forward-looking optimism. I hope you share our vision and will support our on-going efforts. Join, renew, or upgrade by contacting Damon at 206-283-7036 or

We are planning to make a few changes in the Center’s approach to these problems we all face. Instead of publishing LTC Bullets every Friday, we’ll publish periodically as needed to oppose bad research and support promising developments. We’ll use time saved to focus more on writing for outside publication and correcting mistaken or biased media coverage of long-term care financing. Instead of conducting more state and federal studies to re-substantiate what we’ve proved over and over again, we’ll focus on forcing the opposition to consider facts and analysis they’ve evaded.

Thanks for your support.